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Kidney transplantation

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https://www.readbyqxmd.com/read/28340245/unacceptable-human-leucocyte-antigens-for-organ-offers-in-the-era-of-organ-shortage-influence-on-waiting-time-before-kidney-transplantation
#1
Malte Ziemann, Nicole Heßler, Inke R König, Nils Lachmann, Andrea Dick, Vanessa Ditt, Klemens Budde, Petra Reinke, Ute Eisenberger, Barbara Suwelack, Thomas Klein, Timm H Westhoff, Wolfgang Arns, Katrin Ivens, Antje Habicht, Lutz Renders, Dirk Stippel, Dominik Bös, Florian Sommer, Siegfried Görg, Martin Nitschke, Thorsten Feldkamp, Falko M Heinemann, Reinhard Kelsch
Background.: The assignment of human leucocyte antigens (HLAs) against which antibodies are detected as unacceptable antigens (UAGs) avoids allocation of HLA- incompatible allografts. There is uncertainty as to what extent UAGs decrease the probability of receiving a kidney offer. Methods.: Kidney transplantations in 3264 patients on the waiting lists of six German transplant centres were evaluated for a period of at least 2 years. The proportion of excluded offers due to UAGs was calculated as virtual panel-reactive antibodies (vPRAs)...
March 15, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28340239/hypertension-in-dialysis-patients-a-consensus-document-by-the-european-renal-and-cardiovascular-medicine-eureca-m-working-group-of-the-european-renal-association-european-dialysis-and-transplant-association-era-edta-and-the-hypertension-and-the-kidney-working
#2
Pantelis A Sarafidis, Alexandre Persu, Rajiv Agarwal, Michel Burnier, Peter de Leeuw, Charles J Ferro, Jean-Michel Halimi, Gunnar H Heine, Michel Jadoul, Faical Jarraya, Mehmet Kanbay, Francesca Mallamaci, Patrick B Mark, Alberto Ortiz, Gianfranco Parati, Roberto Pontremoli, Patrick Rossignol, Luis Ruilope, Patricia Van der Niepen, Raymond Vanholder, Marianne C Verhaar, Andrzej Wiecek, Gregoire Wuerzner, Gérard M London, Carmine Zoccali
In patients with end-stage renal disease (ESRD) treated with haemodialysis or peritoneal dialysis, hypertension is common and often poorly controlled. Blood pressure (BP) recordings obtained before or after haemodialysis display a J- or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar haemodynamic setting related to dialysis treatment. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival...
March 13, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28340227/transplant-as-a-competing-risk-in-the-analysis-of-dialysis-patients
#3
Nan van Geloven, Saskia le Cessie, Friedo W Dekker, Hein Putter
Time-to-event analyses are frequently used in nephrology research, for instance, when recording time to death or time to peritonitis in dialysis patients. Many papers have pointed out the important issue of competing events (or competing risks) in such analyses. For example, when studying one particular cause of death it can be noted that patients also die from other causes. Such competing events preclude the event of interest from occurring and thereby complicate the statistical analysis. The Kaplan-Meier approach to calculating the cumulative probability of the event of interest yields invalid results in the presence of competing risks, thus the alternative cumulative incidence competing risk (CICR) approach has become the standard...
March 3, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28340216/meta-analysis-of-statins-in-chronic-kidney-disease-who-benefits
#4
C M Messow, C Isles
Background: Attempts to reduce the burden of vascular disease in advanced chronic kidney disease (CKD) by control of lipids have not been as successful as predicted. Aim: : To determine the extent to which the effectiveness of statins varies by kidney class. Design: Meta-analysis. Methods: We selected randomized trials of statin vs. placebo that gave outcomes for CKD3 (eGFR 30-59 ml/min), CKD4 (eGFR 15-29 ml/min), CKD5 (eGFR < 15 ml/min)/5D(dialysis) and transplant patients separately...
March 14, 2017: QJM: Monthly Journal of the Association of Physicians
https://www.readbyqxmd.com/read/28339927/characterizing-the-early-inflammatory-contribution-of-the-donor-kidney-following-reperfusion
#5
John P Stone, Muna Mohamud, Kavit Amin, William R Critchley, Rebecca J Edge, Marc J Clancy, Alexandra L Ball, James E Fildes
Background.: Donor kidneys contain a large reservoir of passenger leucocytes that contribute to acute rejection via direct alloantigen presentation and pro-inflammatory cytokine secretion. However, the early contribution of these cells following revascularization has not previously been described. We performed a secondary, high-volume preservation flush following cold storage to characterize the inflammatory contribution of the donor kidney upon reperfusion. Methods.: Porcine kidneys were retrieved using a protocol analogous to current UK clinical practice...
February 27, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28339910/rituximab-and-hepatitis-b-reactivation-in-hbsag-negative-anti-hbc-positive-kidney-transplant-recipients
#6
Juhan Lee, Jun Yong Park, Kyu Ha Huh, Beom Seok Kim, Myoung Soo Kim, Soon Il Kim, Hoon Sang Ahn, Yu Seun Kim
Background.: Hepatitis B virus (HBV) reactivation is a well-known complication of immunosuppressive therapy. Although rituximab is increasingly used for desensitization of ABO-incompatible or positive crossmatch kidney transplantation, the risk of HBV reactivation in hepatitis B surface antigen (HBsAg)-negative/hepatitis B core antibody (anti-HBc)-positive kidney transplant patients receiving rituximab desensitization remains undetermined. Methods.: We analysed 172 resolved HBV patients who underwent living donor kidney transplantation between 2008 and 2014...
February 23, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28339838/the-clinical-epidemiology-of-young-adults-starting-renal-replacement-therapy-in-the-uk-presentation-management-and-survival-using-15-years-of-uk-renal-registry-data
#7
Alexander J Hamilton, Anna Casula, Yoav Ben-Shlomo, Fergus J Caskey, Carol D Inward
Background: Clinical epidemiology data for young adults on renal replacement therapy (RRT) are lacking. While mostly transplanted, they have an increased risk of graft loss during young adulthood. Methods: We combined the UK Renal Registry paediatric and adult databases to describe patient characteristics, transplantation and survival for young adults. We grouped patients 11-30 years of age starting RRT from 1999 to 2008 by age band and examined their course during 5 years of follow-up...
February 23, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28339671/characteristics-of-donor-specific-anti-hla-antibodies-and-outcome-in-renal-transplant-patients-treated-with-a-standardized-induction-regimen
#8
Daniel Zecher, Christian Bach, Christoph Staudner, Carsten A Böger, Tobias Bergler, Bernhard Banas, Bernd M Spriewald
Background.: Pre-transplant donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) have been associated with antibody-mediated rejection (AMR) and early kidney allograft loss. Uncertainties remain regarding the general applicability of these findings and the optimal induction therapy in DSA-positive patients. Methods.: Pre-transplant sera from 174 patients receiving a crossmatch-negative kidney transplant were retrospectively analysed for DSA using Luminex technology...
February 18, 2017: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/28334964/mutations-in-the-leukemia-inhibitory-factor-receptor-lifr-gene-and-lifr-deficiency-cause-urinary-tract-malformations
#9
Anne Kosfeld, Frank Brand, Anna-Carina Weiss, Martin Kreuzer, Michaela Goerk, Helge Martens, Stephanie Schubert, Anne-Kathrin Schäfer, Vera Riehmer, Imke Hennies, Jan Hinrich Bräsen, Lars Pape, Kerstin Amann, Lars Krogvold, Anna Bjerre, Christoph Daniel, Andreas Kispert, Dieter Haffner, Ruthild G Weber
Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common cause of chronic kidney disease in children. As CAKUT is a genetically heterogeneous disorder and most cases are genetically unexplained, we aimed to identify new CAKUT causing genes. Using whole-exome sequencing and trio-based de novo analysis, we identified a novel heterozygous de novo frameshift variant in the leukemia inhibitory factor receptor (LIFR) gene causing instability of the mRNA in a patient presenting with bilateral CAKUT and requiring kidney transplantation at one year of age...
March 8, 2017: Human Molecular Genetics
https://www.readbyqxmd.com/read/28333861/vouchers-for-future-kidney-transplants-to-overcome-chronological-incompatibility-between-living-donors-and-recipients
#10
Jeffrey L Veale, Alexander M Capron, Nima Nassiri, Gabriel Danovitch, H Albin Gritsch, Amy Waterman, Joseph Del Pizzo, Jim C Hu, Marek Pycia, Suzanne McGuire, Marian Charlton, Sandip Kapur
BACKGROUND: The waiting list for kidney transplantation is long and growing. The creation of "vouchers" for future kidney transplants enables living donation to occur when optimal for the donor and transplantation to occur later, when and if needed by the recipient. METHODS: The donation of a kidney at a time that is optimal for the donor generates a 'voucher' that only a specified recipient may redeem later when needed. The voucher provides the recipient with priority in being matched with a living donor from the end of a future transplantation chain...
March 22, 2017: Transplantation
https://www.readbyqxmd.com/read/28333860/cardiovascular-parameters-to-2-years-after-kidney-transplantation-following-early-switch-to-everolimus-without-calcineurin-inhibitor-therapy-an-analysis-of-the-randomized-elevate-study
#11
Hallvard Holdaas, Johan W de Fijter, Josep M Cruzado, Pablo Massari, Björn Nashan, John Kanellis, Oliver Witzke, Alex Gutierrez-Dalmau, Aydin Turkmen, Zailong Wang, Patricia Lopez, Peter Bernhardt, Jossy Kochuparampil, Markus van der Giet, Klaus Murbraech
BACKGROUND: Mammalian target of rapamycin (mTOR) inhibitors may confer cardioprotective advantages but clinical data are limited. METHODS: In the open-label ELEVATE trial, kidney transplant patients were randomized at 10-14 weeks posttransplant to convert from calcineurin inhibitor (CNI) to everolimus or remain on standard CNI therapy. Prespecified endpoints included left ventricular mass index (LVMi) and, in a subpopulation of patients, arterial stiffness as measured by pulse wave velocity (PWV)...
March 22, 2017: Transplantation
https://www.readbyqxmd.com/read/28333712/disseminated-lichtheimia-ramosa-infection-after-hematopoietic-stem-cell-transplantation-in-a-child-with-chronic-granulomatous-disease
#12
Michael Winstead, John Ozolek, Andrew Nowalk, John Williams, Mark Vander Lugt, Philana Lin
Mucormycosis is uncommon in patients with chronic granulomatous disease (CGD). We report a 7-year-old boy with X-linked CGD and absent oxidative burst who developed fatal Lichtheimia ramosa infection with fungal thrombosis of the kidneys, spleen, and other organs following hematopoietic stem cell transplantation (HSCT). Lichtheimia infection is rarely reported in patients with CGD and could be related to iatrogenic immunosuppression.
March 22, 2017: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/28333603/focal-segmental-glomerulosclerosis-in-a-patient-with-ambiguous-genitalia-a-diagnostic-dilemma
#13
Oliver E Ross, Dean A Kujubu, John J Sim
The renal condition referred to as focal segmental glomerulosclerosis (FSGS) presents a diagnostic dilemma for the clinician. It encompasses and displays a nonspecific histologic appearance on a kidney biopsy specimen, rather than a unique disease entity. This characteristic of FSGS often makes treatment decisions and prognostication difficult. A 34-year-old man, who was born with ambiguous genitalia, had received a diagnosis of FSGS in young adulthood and now had advanced kidney disease. He underwent genetic testing to determine whether a genetic disorder was underlying his kidney disease and to ascertain his risk of FSGS recurrence if he were to receive a kidney transplant...
2017: Permanente Journal
https://www.readbyqxmd.com/read/28333416/severe-transplant-associated-thrombotic-microangiopathy-in-patients-with-hemoglobinopathies
#14
Ghada A Abusin, Rolla Abu-Arja, Rajinder P S Bajwa, Edwin M Horwitz, Jeffery J Auletta, Hemalatha G Rangarajan
Incidence and severity of transplant-associated thrombotic microangiopathy (TA-TMA) in patients with hemoglobinopathies receiving hematopoietic cell transplant is unknown. We report the outcomes for two patients with TA-TMA who received eculizumab. A 2.5-year-old male with sickle cell disease developed TA-TMA-associated pericardial tamponade, severe hypertension, and acute kidney injury 2 months after transplant. A 7-year-old female with β-thalassemia major developed TA-TMA-related acute kidney injury, severe hypertension, and seizures at 6 months after transplant...
March 23, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28332960/evaluation-of-transplanted-kidneys-and-comparison-with-healthy-volunteers-and-kidney-donors-with-diffusion-weighted-magnetic-resonance-imaging-initial-experience
#15
Ümit Özçelik, Halime Çevik, Hüseyin Yüce Bircan, Feza Yarbuğ Karakayalı, İclal Işıklar, Mehmet Haberal
OBJECTIVES: The aim of this study was to evaluate the feasibility of diffusion-weighted magnetic resonance, by comparing imaging in renal allograft recipients for functional assessment of kidney transplants versus imaging of these features in healthy volunteers and kidney donors with native kidneys. MATERIALS AND METHODS: Seventy renal transplant recipients (group A) with stable graft function at postoperative month 1, 40 healthy volunteers (group B), and 40 kidney donors (group C) underwent diffusion-weighted magnetic resonance imaging...
March 22, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28332959/de-novo-donor-specific-antibody-formation-in-tacrolimus-based-mycophenolate-versus-mammalian-target-of-rapamycin-immunosuppressive-regimens
#16
Zain Mithani, Jane Gralla, Oluwafisayo Adebiyi, Patrick Klem, James E Cooper, Alexander C Wiseman
OBJECTIVES: De novo donor-specific antibody formation posttransplant is associated with decreased graft survival. It is not known whether mammalian target of rapamycin inhibitors may be advantageous or detrimental compared with mycophenolate in the prevention of de novo donor-specific antibody formation. MATERIALS AND METHODS: We compared 66 kidney and kidney-pancreas transplant recipients who received tacrolimus, mammalian target of rapamycin inhibitor, and prednisone (group 1; 36 of whom received everolimus and 30 of whom received sirolimus) versus 132 patients who received tacrolimus, mycophenolate, and prednisone (group 2) matched for age, sex, race, and type/timing of transplant from 2007 to 2012...
March 22, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28332958/effect-of-prediabetes-on-allograft-survival-and-evolution-of-new-onset-diabetes-after-transplant-in-deceased-donor-kidney-transplant-recipients-during-long-term-follow-up
#17
Frank Peter Tillmann, Amira Radtke, Lars Christian Rump, Ivo Quack
OBJECTIVES: This study investigated the effect of prediabetes in long-term deceased-donor renal transplant recipients regarding graft survival, graft function, and evolution of new-onset diabetes after transplant compared with a control group of graft recipients with normal glucose tolerance test results. MATERIALS AND METHODS: This was a follow-up trial of 187 deceased-donor renal transplant recipients. Based on oral glucose tolerance test results, the cohort was divided into groups A and B, comprising individuals with normal glucose metabolism (n = 130, 69...
March 22, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28332957/three-dimensional-computed-tomography-reconstruction-in-transplant-renal-artery-stenosis
#18
Xufeng Zhang, Hongwei Wang, Shuangde Liu, Jieke Yan, Xiaoli Liu, Dongsheng Xu, Chuan Tian
OBJECTIVES: Transplant renal artery stenosis is a frequently recognized complication of kidney transplant procedures. A single-center retrospective study was conducted to examine the use of 3-dimensional computed tomography reconstruction in diagnosing transplant artery stenosis. MATERIALS AND METHODS: During 2013 at our center, 86 patients underwent kidney transplant. All patients underwent ultrasonographic analyses. Patients with clinically suspected transplant renal artery stenosis were examined by 3-dimensional computed tomography reconstruction and were treated with endovascular approaches or medically managed...
March 22, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28332956/high-urinary-aspartate-aminotransferase-in-the-late-posttransplant-period-predicts-rapid-progressive-decline-in-kidney-allograft-function
#19
Andriy V Trailin, Marina V Pleten, Tatiana I Ostapenko, Nadia F Iefimenko, Olexander S Nikonenko
OBJECTIVES: Scant information is available on factors for predicting the rate of decline in kidney allograft function beyond 1 year posttransplant.We investigated whether urinary enzymes (alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, N-acetyl-β-D-hexosaminidase, and ε-glutamyl transpeptidase) in the late postoperative period can predict the decline in estimated glomerular filtration rate. MATERIALS AND METHODS: In 79 kidney allograft recipients 1 to 17 years after kidney transplant, we assessed a value of urinary enzymes single measurement for predicting the slope of estimated glomerular filtration rate, rapid decline in estimated glomerular filtration rate (> 5 mL/min/1...
March 22, 2017: Experimental and Clinical Transplantation
https://www.readbyqxmd.com/read/28332729/transplantation-of-kidneys-from-hepatitis-c-positive-donors-into-hepatitis-c-virus-infected-recipients-followed-by-early-initiation-of-direct-acting-antiviral-therapy-a-single-center-retrospective-study
#20
Kalyan Ram Bhamidimarri, Marco Ladino, Fernando Pedraza, Giselle Guerra, Adela Mattiazzi, Linda Chen, Gaetano Ciancio, Warren Kupin, Paul Martin, George Burke, David Roth
The availability of direct acting antiviral agents (DAA) has transformed the treatment of hepatitis C virus (HCV) infection. The current study is a case series that reports the outcomes from a cohort of twenty-five HCV-infected ESRD patients who received a kidney from an anti-HCV-positive deceased organ donor followed by treatment with DAAs in the early post-transplant period. Time to transplantation and the efficacy of DAA therapy as measured by sustained viral response at 12 weeks were assessed. The median waiting time from original date of activation on the UNOS waiting list until transplantation was 427 days, however, the median time from entering the patient into UNet(sm) for a HCV positive offer until transplantation was only 58 days...
March 23, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
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